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Stop Work Authority Form

Section 1: Stop Work Issuance

Date & Time Vessel Name

Location Wind & Seas

Captain/Master

Individual initiating stop


work

Individual performing
work
Work operation or condition (include names of individuals performing work)

Hazard (as stated by individual initiating stop work)

Additional observations

Section 2: How was this situation mitigated?

Captain

Operations Manager

Safety Manager

Employee who initiated


stop work

HSSE-Stop Work 2021 STOP WORK AUTHORITY

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